Healthcare Provider Details

I. General information

NPI: 1598371247
Provider Name (Legal Business Name): CENTURY MEDICAL CENTER OF SOUTH DADE ,L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 SW 107TH AVE
MIAMI FL
33165-7344
US

IV. Provider business mailing address

1645 SW 107TH AVE
MIAMI FL
33165-7344
US

V. Phone/Fax

Practice location:
  • Phone: 954-331-4966
  • Fax: 954-212-8486
Mailing address:
  • Phone: 954-331-4966
  • Fax: 954-212-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: CARIDAD MIREYA GALLARDO PIMENTEL
Title or Position: PRESIDENT
Credential: APRN
Phone: 954-331-4966